Workers Compensation Claims Specialist (NE Region)

About the role

Zurich is seeking a Workers Compensation Claims Specialist II for its Northeast region. The role offers a hybrid work schedule from Parsippany or Boston offices, or a fully remote setup in one of the following states: Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia.

Responsibilities

• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
• Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
• Exercise judgement to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
• Develop case strategy; develop a case evaluation; escalate issues as appropriate.
• Estimate and validate value of claims; establish timely reserves and perform ongoing review throughout claims cycle within authority limit.
• Calculate applicable damages or range of damages allowed by law; negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• Meet quality standards by following best practices; ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and participating in customer marketing efforts.
• Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Depart from approved vendors with manager approval, where in the best interests of the insured.
• Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
• Provide risk insight, information, and trends to Business Unit or customer as needed.
• Protect Zurich’s reputation by keeping claims information confidential.
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.

Requirements

• Bachelor’s Degree and 3 or more years of experience in the Claims or Insurance area OR Zurich Certified Insurance Apprentice, including an Associate Degree and 3 or more years of experience in Claims or Insurance area OR Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area OR High School Diploma or Equivalent and 5 or more years of experience in the Claims or Insurance area.
• Must obtain and maintain required adjuster license(s).
• Knowledge of insurance regulations, markets, and products; Microsoft Office experience.

Qualifications

• Basic Qualifications: Bachelor’s Degree and 3 or more years of experience in the Claims or Insurance area OR Zurich Certified Insurance Apprentice, including an Associate Degree and 3 or more years of experience in Claims or Insurance area OR Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area OR High School Diploma or Equivalent and 5 or more years of experience in the Claims or Insurance area AND Must obtain and maintain required adjuster license(s).
• Preferred Qualifications: 4+ years of experience in the Workers Compensation line of business, 3+ years of experience handling litigation management, specialization in PA jurisdiction with knowledge of NJ and/or VA jurisdictions, learning and handling additional jurisdictions as needed, EDI filing requirements, MSA/Medicare knowledge, WCCA, WCCP Designations, knowledge and skill of claims handling, negotiation experience, experience in line of business, excellent communication skills, analytical skills.

Benefits

The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $59,900.00 - $98,200.00, with short-term incentive bonus eligibility set at 10%. We offer competitive pay and comprehensive benefits for employees and their families.